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Massachusetts rates for HCPCS 15221

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.84 / $1,845.24 / $3,469.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.74 / $106.01 / $187.32
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.86 / $941.10 / $4,142.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.20 / $183.06 / $1,392.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.68 / $102.28 / $197.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.09 / $153.24 / $344.76
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.97 / $300.00 / $6,679.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.62 / $177.85 / $245.50
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.38 / $177.05 / $345.67
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$333.88 / $1,818.00 / $16,394.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.78 / $257.22 / $1,510.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.00 / $1,818.00 / $2,733.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.08 / $195.29 / $350.26